The Medical Home Transformation in Pediatric Primary Care - What Drives Change study will identify the drivers and obstacles to medical home transformation and to the sustainability of change in 10 transformed primary care pediatric family-centered medical homes (FCMH). The long-term objectives include: 1) identify key internal and external factors affecting transformation;2) describe the business models used to sustain transformation;3) evaluate the contribution of facilitation, technical assistance, and other quality improvement supports;4) assess transformation's impact on staff, patients, and families;5) identify characteristics unique to the pediatric medical home and pediatric practice transformation compared to the adult care models;6) communicate findings to multiple stakeholders included practices, policy makers, payers, families, and medical educators and training programs. Ten transformed pediatric practices and three alternates were identified from among the highest performing practices in taking part in two yearlong national medical home learning collaboratives between 2003 and 2006 based on improvements between their pre- and post-collaborative Medical Home Index (MHI) scores. All practices will complete the CMHI TAPPP gap analysis tool, which includes the MHI and assesses medical home qualities on a number of dimensions including readiness for NCQA recognition. A traveling study team will review the TAPPP data and then visit all ten practices to conduct multiple semi-structured interviews with key practice staff and parents of children with and without chronic conditions. The five practices with the highest TAPPP scores will provide additional quantitative data related to quality of care including 150 chart audits and CAHPS 2 surveys of 30 families from each practice. Analysis of interview results will be subjected to a thematic analysis using NVIVO 8 software. Quantitative survey and chart audit data will be analyzed for indicators of quality that will be incorporated into the analysis of the interviews from the five high- performing practices. Results will be disseminated through a partnership with the American Academy of Pediatrics and its National Center for Medical Home Implementation. PUBLIC HEALTH RELEVANCE: The relevance of this study pertains to the widespread belief that transformed primary care will not only produce improved health outcomes, but also reduce costs and increase the attractiveness of careers in primary care. This study will enhance understanding of the factors needed to transform pediatric care and sustain a pediatric family-centered medical home in the context of a medical home transformation movement that has been largely focused on adult health care.